Saturday, August 29, 2009

Hundreds more report ill-treatment in British public hospitals

Health campaigners were “overwhelmed” by hundreds of e-mails and calls yesterday after publishing a report into poor care suffered by more than a dozen NHS patients. The Patients Association said that it had received a huge response from the public after publishing stories of people left lying in their own faeces and urine, having call bells taken away from them or being left without food or drink.

In a statement, the charity accused the Government of “ignoring the scale of the problem”, adding: “We’ve been inundated by hundreds of e-mails and calls from patients across the country contacting us to offer their support and relate their own experiences of poor care. “It is very clear, that whilst still representing a small proportion of the care being given by the NHS, the numbers of people receiving substandard care are not small. The NHS treats millions of patients each year. Even if 2 per cent of these are given substandard care this equates to tens of thousands of people.”

The Conservatives revealed figures that showed about 1,000 people a year were dying with pressure sores in England and Wales. The condition, linked to poor hygiene and long periods spent bed-ridden in hospital or at home, has been cited regularly on death certificates over the past five years, a response to a parliamentary question disclosed.

The Department of Health maintained that surveys show that 98 per cent of NHS patients are satisfied with their care. However, the Government’s Chief Nursing Officer said that the treatment of some of the 16 patients mentioned in the Patients Association’s report, was “clearly unacceptable”. Christine Beasley added that nurses who were accused of neglecting patients could be investigated and struck off by the Nursing and Midwifery Council (NMC). “They [the stories] make not only very distressing reading for patients but very sombre reading for the nursing profession,” she said. “I think any nurse that provides that sort of care — or in fact does not provide that sort of care — should be treated very, very seriously and if necessary, if it’s at that level, should absolutely be struck off.”

Each NHS trust implicated in the report was offered the opportunity to respond to the allegations. Many said that they had carried out their own investigations into what had happened, or said that complaints continued to be dealt with by the indepedent Health Ombudsman. There were no details about whether any individual nurses had been investigated or sanctioned by the NMC, which regulates the 600,000 nurses working in Britain.

The Council said it received more than 2,000 initial allegations from NHS employers, the police and the public in 2008-09, of which 584 went to a hearing. As a result, 216 nurses and midwives were struck off.

The Department of Health said that any patient who wished to complain about poor care should first contact the service that they were unhappy with, or the local primary care trust that commissioned the service, typically within 12 months. Where complaints cannot be resolved at a local level, or if complainants are still unhappy, they can refer the matter to the Parliamentary and Health Service Ombudsman for review.

Anne Milton, MP, the Conservative health spokeswoman, said: “NHS frontline staff are currently being overburdened by red tape and paperwork and are consistently being spread too thin and too wide across the service. They must be released to do the job that they are there to do — to help people — or risk yet more unnecessary and needless deaths.”


Britain's worst nurses 'must be struck off'

That they weren't struck off years ago is the disgrace

Nurses who neglect elderly patients should be struck off, the Government’s Chief Nursing Officer said today. Christine Beasley said that a report into the poor care of more than a dozen elderly patients, published by the Patients Association, was distressing and should make “sombre reading for the nursing profession”. A report from the charity released today includes stories of people left lying in their own faeces and urine, having call bells taken away from them and being left without food or drink.

The report was published as NHS nurses came under fire for their “cruel” and “demeaning” treatment of patients, in particularly the elderly.

The Conservatives said today that about 1,000 people a year were dying from pressure sores in England and Wales. The condition, linked to poor hygiene and long periods in hospital or at home, has been cited regularly on death certificates over the last five years, a response to a parliamentary question disclosed.

Anne Milton, MP, the Conservative health spokeswoman, said: “This is yet more evidence that the strain that Labour’s tick-box target culture is putting on NHS staff is having a devastating effect on hundreds of patients and families in the UK. “NHS frontline staff are being overburdened by red tape and paperwork and are consistently being spread too thin and too wide across the service. They must be released to do the job that they are there to do — to help people — or risk yet more unnecessary and needless deaths.

“The Government urgently needs to learn the lessons of the appalling standards of care that patients were subjected to in Mid Staffordshire. No patient should develop pressure sores while in care, let alone have them contribute to their death.”

Ms Beasley said that the care offered to some of the patients mentioned in the Patients Association’s report was clearly unacceptable. She added: “They [the stories] make not only very distressing reading for patients but very sombre reading for the nursing profession. “I think any nurse that provides that sort of care — or in fact does not provide that sort of care — should be treated very, very seriously and if necessary, if it’s at that level, should be struck off.

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Australia: Yet another serious government ambulance bungle

These episodes just keep coming

TAPES of a 000 emergency call reveal how a Wynnum family was put on hold by an ambulance dispatcher who bungled a response to a man suffering a stroke. Marcia Fielder, 80, said her son had to be privately transported to hospital after the Queensland Ambulance Service decided it could take up to one hour to respond.

The 44-year-old man, whom the family does not wish to name, suffered an embolic stroke in July last year and has since lost his job and become reclusive.

In a letter to Mrs Fielder the QAS admitted their response was "regrettable" and advised that the dispatcher had been removed from his position. Mrs Fielder called 000 last July after her son complained of a severe headache and not being able to see "the bottom half of the room". She said his mind then appeared to go entirely blank and he didn't even recognise her or know what room of the house he was in. "I must admit I became hysterical. I had never seen him that way before," she said.

The incident has raised more questions over the standard of training being offered to QAS dispatchers. The Courier-Mail has listened to tapes of the 000 call, which confirm the QAS dispatcher did not understand the urgency of the condition.

Mrs Fielder had to wait for her other son to drive from Salisbury to Wynnum to take them to Redlands Hospital. The next day a brain scan showed her son had suffered two strokes. He has lost his ability to read and is no longer employed.

Mrs Fielder believed her son, whom she described as a gentle giant who always cared for her, didn't want to speak out because he was embarrassed over the incident. "You have no idea how he's changed. It's like his life's lost," she said. "He stays in his room and when people ring up he says to tell them he's not home."

In a letter to Mrs Fielder, Queensland Ambulance Service medical director Stephen Rashford said paramedics were struggling with a high workload on that night. "The EMD (emergency medical dispatcher) should have provided you with more assurance and empathy," Dr Rashford wrote. "It was also found that the manner in which the EMD spoke to you was extremely inappropriate. "I apologise that the level of service provided by the EMD was not at the level of your or your son's expectations." [Does this asshole thinks lack of politeness was the only problem??]


Obama Targets Medicare Advantage

Seniors would lose with health 'reform,' -- and seniors vote


President Barack Obama was wise to vacation this week on Martha's Vineyard. Not because it's one of the few places in America where his health-care plan is still popular, but because by getting out of Washington he gave staff time to repair his vaunted message machine, which was starting to break down.

Two weeks ago, White House Senior Adviser David Axelrod said in a now legendary "viral" email that, "It's a myth that health insurance reform would be financed by cutting Medicare benefits." This was sent out the day before Mr. Obama told a Montana town hall that he'd pay for health-care reform by "eliminating . . . about $177 billion over 10 years" for "what's called Medicare Advantage." And it was two days before Mr. Obama told a Colorado town hall he'd cover "two-thirds" of the "roughly $900 billion" of his plan's cost by "eliminating waste," again citing Medicare Advantage.

Who's right? As a former senior adviser, I can tell you who: the president. What's more, according to a White House fact sheet titled "Paying for Health Care Reform," Mr. Axelrod was misleading his readers. It notes the administration would cut $622 billion from Medicare and Medicaid, with a big chunk coming from Medicare Advantage, to pay for overhauling health care. Mr. Obama heralded these cuts as "common sense" in his June 13 radio address.

Medicare Advantage was enacted in 2003 to allow seniors to use Medicare funds to buy private insurance plans that fit their needs and their budgets. They get better care and better value for their money.

Medicare Advantage also has built-in incentives to encourage insurers to offer lower costs and better benefits. It's a program that puts patients in charge, not the government, which is why seniors like it and probably why the administration hates it.

Already, an estimated 10.2 million seniors—one out of five in America—have enrolled in Medicare Advantage. Mr. Obama is proposing to cut the program by nearly 20% and thus reduce the amount of money each will have to buy insurance. This will likely force most of them to lose the insurance they have now. Yet Mr. Obama promised in late July in New Hampshire that, "if you like your health-care plan, you can keep your health-care plan."

There are roughly 23,400 seniors on average in a congressional district who have Medicare Advantage, but who face losing it if Mr. Obama has his way. That's enough votes to tip most competitive House and Senate races.

Back in 2006, Mr. Obama and other Democrats railed against GOP efforts—modest though they were—to slow future Medicare spending growth. Now he and his party may reap what they have sown. As the president pushes to enact an overall cut to Medicare he will imperil Democrats in tough re-election races. Mr. Obama has a dangerous old tiger by the tail. Seniors are much more likely to vote than the population at large.

Adding to the Democrats' woes are polls that show weak support for ObamaCare among Independents and Democrats. In the new ABC/Washington Post poll, only 45% approved of Mr. Obama's plan and 50% opposed it—with 40% "strongly" opposed.

Despite Mr. Obama's barnstorming tour, last week's Fox/Opinion Dynamics poll said "the health care reform legislation being considered right now" is opposed by 21% of Democrats, 50% of Independents, and 81% of Republicans. Only 37% of Democrats and 15% of Independents think their families would be better off if it passed.

The problem for Mr. Obama is that he lacks credibility when he asserts his plan won't add to the deficit or won't lead to rationing; that people can keep their health plans; that every family's health care will be better, not worse; and that a government run plan isn't a threat to private insurance. A large number of Americans don't believe the president on this.

With this week's $2 trillion upward revision in the White House's deficit projections, August has been the cruelest month for Mr. Obama. The president is now facing a politically explosive mix of unpopular policies and an angered electorate.

It's still too early to count Mr. Obama out. His team will be back in Washington next week. They'll work on their messaging and have more than $100 million—much of it from pharmaceutical companies—to spend on ads bludgeoning reluctant Democrats and energized Republicans.

The White House will exert enormous pressure—and in the spirit of Chicago-style politics, employ threats when necessary—with Senate and House Democrats. The health-care battle, already intense, will get more so in the months ahead. ObamaCare is unpopular, but it is far from defeated.


Obama's Health Rationer-in-Chief

White House health-care adviser Ezekiel Emanuel wants to discriminate against the elderly and babies -- who are often most in need of medical help. You are just a statistic to him. He's got all the heart of a stone. So much for all that Leftist "caring" and "compassion"

Dr. Ezekiel Emanuel, health adviser to President Barack Obama, is under scrutiny. As a bioethicist, he has written extensively about who should get medical care, who should decide, and whose life is worth saving. Dr. Emanuel is part of a school of thought that redefines a physician’s duty, insisting that it includes working for the greater good of society instead of focusing only on a patient’s needs. Many physicians find that view dangerous, and most Americans are likely to agree.

The health bills being pushed through Congress put important decisions in the hands of presidential appointees like Dr. Emanuel. They will decide what insurance plans cover, how much leeway your doctor will have, and what seniors get under Medicare. Dr. Emanuel, brother of White House Chief of Staff Rahm Emanuel, has already been appointed to two key positions: health-policy adviser at the Office of Management and Budget and a member of the Federal Council on Comparative Effectiveness Research. He clearly will play a role guiding the White House's health initiative.

Dr. Emanuel says that health reform will not be pain free, and that the usual recommendations for cutting medical spending (often urged by the president) are mere window dressing. As he wrote in the Feb. 27, 2008, issue of the Journal of the American Medical Association (JAMA): "Vague promises of savings from cutting waste, enhancing prevention and wellness, installing electronic medical records and improving quality of care are merely 'lipstick' cost control, more for show and public relations than for true change."

True reform, he argues, must include redefining doctors' ethical obligations. In the June 18, 2008, issue of JAMA, Dr. Emanuel blames the Hippocratic Oath for the "overuse" of medical care: "Medical school education and post graduate education emphasize thoroughness," he writes. "This culture is further reinforced by a unique understanding of professional obligations, specifically the Hippocratic Oath's admonition to 'use my power to help the sick to the best of my ability and judgment' as an imperative to do everything for the patient regardless of cost or effect on others."

In numerous writings, Dr. Emanuel chastises physicians for thinking only about their own patient's needs. He describes it as an intractable problem: "Patients were to receive whatever services they needed, regardless of its cost. Reasoning based on cost has been strenuously resisted; it violated the Hippocratic Oath, was associated with rationing, and derided as putting a price on life. . . . Indeed, many physicians were willing to lie to get patients what they needed from insurance companies that were trying to hold down costs." (JAMA, May 16, 2007).

Of course, patients hope their doctors will have that single-minded devotion. But Dr. Emanuel believes doctors should serve two masters, the patient and society, and that medical students should be trained "to provide socially sustainable, cost-effective care." One sign of progress he sees: "the progression in end-of-life care mentality from 'do everything' to more palliative care shows that change in physician norms and practices is possible." (JAMA, June 18, 2008).

"In the next decade every country will face very hard choices about how to allocate scarce medical resources. There is no consensus about what substantive principles should be used to establish priorities for allocations," he wrote in the New England Journal of Medicine, Sept. 19, 2002. Yet Dr. Emanuel writes at length about who should set the rules, who should get care, and who should be at the back of the line.

"You can't avoid these questions," Dr. Emanuel said in an Aug. 16 Washington Post interview. "We had a big controversy in the United States when there was a limited number of dialysis machines. In Seattle, they appointed what they called a 'God committee' to choose who should get it, and that committee was eventually abandoned. Society ended up paying the whole bill for dialysis instead of having people make those decisions."

Dr. Emanuel argues that to make such decisions, the focus cannot be only on the worth of the individual. He proposes adding the communitarian perspective to ensure that medical resources will be allocated in a way that keeps society going: "Substantively, it suggests services that promote the continuation of the polity—those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations—are to be socially guaranteed as basic. Covering services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic, and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." (Hastings Center Report, November-December, 1996)

In the Lancet, Jan. 31, 2009, Dr. Emanuel and co-authors presented a "complete lives system" for the allocation of very scarce resources, such as kidneys, vaccines, dialysis machines, intensive care beds, and others. "One maximizing strategy involves saving the most individual lives, and it has motivated policies on allocation of influenza vaccines and responses to bioterrorism. . . . Other things being equal, we should always save five lives rather than one.

"However, other things are rarely equal—whether to save one 20-year-old, who might live another 60 years, if saved, or three 70-year-olds, who could only live for another 10 years each—is unclear." In fact, Dr. Emanuel makes a clear choice: "When implemented, the complete lives system produces a priority curve on which individuals aged roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get changes that are attenuated.

Dr. Emanuel concedes that his plan appears to discriminate against older people, but he explains: "Unlike allocation by sex or race, allocation by age is not invidious discrimination. . . . Treating 65 year olds differently because of stereotypes or falsehoods would be ageist; treating them differently because they have already had more life-years is not."

The youngest are also put at the back of the line: "Adolescents have received substantial education and parental care, investments that will be wasted without a complete life. Infants, by contrast, have not yet received these investments. . . . As the legal philosopher Ronald Dworkin argues, 'It is terrible when an infant dies, but worse, most people think, when a three-year-old dies and worse still when an adolescent does,' this argument is supported by empirical surveys."

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